REQUEST FOR PROFESSIONAL LEAVE OR TRAVEL

							                                                                                                                                             Clear Form
                                      REQUEST FOR PROFESSIONAL LEAVE OR TRAVEL
Name                                            Title                                               Department
Office Address                                                                                      Office Phone #
Home Address                                                                                        Home Phone #

I,                                                                                    , request permission from professional leave or travel from
                   a.m./p.m. on                   (date) until                           a.m./p.m. on                                        (date)
This leave request is for:                                       professional leave                         consulting                        other

       Specific purpose:
       Destination, if travel is involved:

Will any classes or assignments be missed?                             no.               yes.           If yes, indicate below what
arrangements have been made for appropriate coverage.

       Indicate below those classes that will be missed:

                         Course                                  # of Days Missed                           Coverage




       Explanation of class coverage:




       Indicate coverage for the type of responsibilities that will be met:




Is reimbursement of expenses requested?                          no.                  yes.          If yes, complete expense estimate below.


       Transportation:
                Plane
                Private/University Car

       Lodging and Meals:
                Per Diem (In-State)
                Lodging (Out-of-State)
                Meals (Out-of-State)

       Conference Registration Fees:

       Other:




       Total Estimated Cost (not necessarily amount of reimbursement):                                                               $0.00




                             Signature of Requester                                                                           Date
Travel Authorization Form

Complete the following for International Travel:

Passport No.                                    Expiration Date                                        Date/Place of Issue
Emergency Contact                                                                                      Relationship
Address
Telephone/Fax/Day                                                                                 Night
Are you covered by medical insurance?                                          Yes                       No
Name of insurance provider:

Attach itinerary of travel (where you can be reached, if necessary)
For additional protection, we recommend you apply for a Council International Identification card. For information and
application forms, contact the Office of International Programs at (251) 460-7053.


                              AUTHORIZATION FOR PROFESSIONAL LEAVE OR TRAVEL

I approve the leave or travel requested on the attached form as being in the best interest of the University. Reimbursement
for expenses incurred is approved in the following accounts:


                                                                       Program                 Activity               Location
      Fund           Organization              Account               (Bus Off Use)             Optional               Optional   Amount




                                                  Leave and/or travel is approved, but no reimbursement is approved.


APPROVED BY:


                      DEPARTMENT CHAIR




                      DEAN




                      DIRECTOR OF INTERNATIONAL PROGRAMS
                      (Required only for travel beyond the contiguous forty-eight states
                      and the District of Columbia)




                      SENIOR VICE PRESIDENT FOR ACADEMIC AFFAIRS
                      (Required only for individuals reporting directly to the Senior Vice-President
                      or for travel beyond the contiguous forty-eight states and the District of Columbia)




                      PRESIDENT
                      (Required only for travel beyond the contiguous forty-eight states
                      and the District of Columbia)